This page has been edited 2 times. The last modification was made by - judithcbliss on Nov 9, 2014 10:28 am
CCRMC OBGYN Prenatal Guideline
Consultation available 24 hours per day from OB on-call at 925-370-5608 or via page/amion, via inbasket to OB dept member or by calling Perinatologist at 510-444-0790 during the day and 510-204-1572 after hours.
Consultation appointments or transfer of care to more experienced prenatal clinician available at major clinics sites—see consultation guidelines for more information.
Cholestasis of Pregnancy
Diagnosis:
Generalized pruritis without rash or other lesion as explanation occurring in second or third trimester. May have excoriations from scratching.
Order bile acids and LFTs. Bile acids are ideally done fasting but for logistical reasons and to avoid delay they are usually drawn and run regardless of fasting state.
Elevated transaminases and pruritis are usually enough for presumptive diagnosis, monitoring and treatment pending bile acid result. Note alk phos is normally elevated and albumin is normally low in pregnancy
Any elevation in bile acid is considered positive. To confirm than can be re-checked fasting, if she is not yet on treatment (Urosodiol)
Treatment:
Urosodiol (Actigall) 300mg bid to tid. This will relieve itching and lower bile acids. It has not been shown to decrease incidence of fetal demise.
Start Antepartum testing pending bile acids if gestational age > 28 weeks.
Induction of Labor at 37 weeks or diagnosis if later. Usually induce only if documented elevated bile acid but may consider with symptoms/transaminases if compelling history i.e. prior induction for cholestasis.
Antepartum testing appts can be used to follow up on lab results concurrent with monitoring
More significantly elevated bile acids >40 indicate higher risk for demise
Consultation with OB Dept physician recommended especially for higher bile acids, earlier diagnoses, or uncertain cases.
This page has been edited 2 times. The last modification was made by -
CCRMC OBGYN Prenatal Guideline
Consultation available 24 hours per day from OB on-call at 925-370-5608 or via page/amion, via inbasket to OB dept member or by calling Perinatologist at 510-444-0790 during the day and 510-204-1572 after hours.
Consultation appointments or transfer of care to more experienced prenatal clinician available at major clinics sites—see consultation guidelines for more information.
Cholestasis of Pregnancy
- Generalized pruritis without rash or other lesion as explanation occurring in second or third trimester. May have excoriations from scratching.
- Order bile acids and LFTs. Bile acids are ideally done fasting but for logistical reasons and to avoid delay they are usually drawn and run regardless of fasting state.
- Elevated transaminases and pruritis are usually enough for presumptive diagnosis, monitoring and treatment pending bile acid result. Note alk phos is normally elevated and albumin is normally low in pregnancy
- Any elevation in bile acid is considered positive. To confirm than can be re-checked fasting, if she is not yet on treatment (Urosodiol)
Treatment:.